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Housing is one of the challenges of our time. The task for architects and designers is to create affordable, robust housing that can accommodate the needs of a rapidly growing, but also ageing population. And it’s not as easy as simply building. The demands and expectations on house builders to also be community builders and the architects of mental and physical wellbeing through design have led architects and designers to consider alternative ways to house us in the future. This includes innovative use of materials and construction methods, addressing the issue of financing through co-operative living models and using bespoke design to create lifetime homes which can be adapted to accommodate the changing needs of our population.

Large-scale development

One of the big challenges for urban areas is large-scale development strategies for designing and delivering housing to meet need. For developers and planners going forward there are a number of factors to consider: the type of investment introduced to an area; how the schemes fit with a wider development plan for the city; and the importance of engaging the community in any plans to develop or regenerate an area.

“Placemaking”, not just house building is central to large scale development discussions, emphasising to planners, architects and developers the fact that they are not just building houses, but creating communities. As a result, designers and developers should be mindful of their important role in community building, to build the right sort of homes in the right places, at affordable prices and with a legacy in mind. They should, create high quality, long lasting units, which will stand the test of time but that also can be easily adapted to accommodate people’s changing needs.

Alternative construction and design

Innovative models and options for future builds have been discussed for a number of years but they are becoming an increasingly mainstream way to build affordable housing that meets the current need, particularly of students and young professionals, and of older populations looking to downsize or move into assisted care accommodation.

Offsite manufacture or modular homes –Offsite manufacture of timber framed houses is becoming increasingly common, with the constituent pieces of the house manufactured off site, then transported to the site and constructed on a concrete block where foundations and services such as plumbing have already been created. Offsite housing can either be open panel, which requires the finishing such as bathroom and kitchen installation to be done on site, or closed panel which provide the entire section complete with decoration and flooring (this is becoming a common way to build cheap, efficient student housing).

Custom build – Custom build projects are similar to self-build in that they give clients flexibility to select their own design and layout, However, custom build provides slightly more structure and certainty which can make it easier when considering elements like financing and planning applications. In essence, customers select the spec of their house in the same way they might make custom modifications to a car.

Build to rent – This model has been adapted from the United States, where build to rent is popular. The model is based on self-contained flats, with central and shared amenities, entrance and communal space. Designed to attract graduates and young professionals, these are being increasingly designed using a “user first” approach. Developers identify the sort of person they want to live in the development, identify what sort of things they might look for in a development, including floor type, furniture, layout, amenities, gadgets, and then build the development around that.

Dementia friendly – Building homes that are safe and affordable, but allow for independence in old age, is one of the major demands on house builders currently. Housing stock is seen as not suitable for current need, but building bespoke sites for people with illnesses like dementia has been seen as a bit of a niche previously. Virtual Reality (VR) is being used by some architects and developers to try to help them understand the needs and requirements of people with dementia and how they can build homes suitable for them to be able to live as independent and full lives as possible. Building dementia friendly homes not only means making them accessible and open plan, but also adapting the layout, adding signage where appropriate and if possible locating the homes within a wider community development. Dementia villages like those seen in Amsterdam are being used as the model for this.

Co-housing

Co- housing offers an alternative to communities in Scotland, and while lessons can be learned from elsewhere in Europe, where co- housing models have been successful, there are also pockets of good and emerging practice in the UK too. More traditional examples include Berlin, where almost 1 in 10 new homes follow the Baugruppe model, and Amsterdam (centraal wonen) where some of the oldest co-housing projects originate. In Denmark, 8% of households use co-housing models.

Co-housing provides the opportunity for groups of people to come together and form a community which is created and run by its residents. Each household has a self-contained, private home as well as shared community space. Residents come together to manage their community, share activities, and regularly eat together. A “Self-build Cooperative Group” is a joint venture between several private households who plan and build their own house together. Usually they are supported by an architect. Often co- housing groups are able to realise high-quality living space at prices below local market rates, although it is not really considered suitable for large-scale development within the current UK market.

Opportunities for a new way forward

Practitioners are often challenged to push the boundaries of design and building in their field. Looking to new models for future building design provides an opportunity to think creatively about alternative uses of materials and space and to consider options for construction, funding and investment in the built environment that challenge the norm. Learning lessons and exchanging ideas from elsewhere, architects and planners have the opportunity to come together to consider how the built environment in Scotland can help to create places – not just buildings – and how this can contribute positively to the wider wellbeing and happiness of people living in Scotland in the future.

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People diagnosed with dementia can live independently for many years – in fact, 1 in 3 people with dementia are still able to drive safely. However, as the disease progresses, people with dementia must eventually stop driving. Public transport can be a good alternative to driving for those in the early stages of dementia, enabling them to stay connected with their families, friends and local communities, and provide access to healthcare.

Indeed, the provision of easily accessible public transport options is a key aspect of dementia-friendly communities. It is difficult to overstate its importance:

“If I didn’t have coping strategies to remain independent and mobile I’d be very lonely and soon sink into depression. Travel brings normality to an often abnormal life” Wendy Mitchell, recording a Dementia Diary for Upstream

However, the challenges faced by people with dementia mean that travelling by public transport can be daunting. This is because dementia affects more than just memory. Environments that are noisy and busy can be extremely disorientating for people with dementia, particularly when there are added time-sensitive elements such as bus or train times.

People with dementia often lose the confidence to travel. They may experience difficulties purchasing the correct tickets, become confused by different fares or travel options, or feel hurried or pressured. They may feel anxious or unsafe, for example, when becoming separated from their luggage or they may have a fear of becoming lost, or getting off at the wrong stop/station.

In addition to the cognitive, emotional and sensory challenges faced by people with dementia when travelling, there are a number of additional barriers. These include:

Difficulties with journey planning

The use of fast changing technology which can exclude certain groups of people

In regards to transport improvements specifically, earlier this year, the Bus Services Act gained royal assent in England. The Act provides powers to ensure that buses make both audible and visual announcements about the route and the next stop. These reminders can help to reassure people with dementia. The government has committed to work alongside the bus industry, passengers and disability groups to develop the policy further.

The government is also currently consulting on a draft ‘Accessibility Action Plan’, which addresses the barriers faced by people with disabilities using public transport, including a focus on hidden disabilities, such as dementia. It also commits to updating existing guidance on ‘inclusive mobility’ to incorporate current knowledge and understanding of the needs of those with hidden disabilities such as dementia.

Involving people with dementia in service design

Involving people with dementia in the design of services can help to ensure that their needs are addressed. Upstream is a project that does just that. It helps to give people living with dementia across Scotland a voice in the design of future mobility services.

Projects have involved visiting various groups in the Western Isles to learn about the challenges of island transport, workshops to gather insights about travel with Dementia Friendly East Lothian and the North Berwick Coastal Area Partnership; and developing training programmes in conjunction with transport providers. They have produced a report of their work so far.

Use of technology

The expansion of real time audio and visual information as set out in the Bus Services Act provides a good example of where technology can be used to make transport more accessible for people with dementia and other disabilities.

Other ways in which technology may help include the expansion of live departure boards at bus stops and increasing the use of journey planners – either online or via the telephone. Apps may also have the potential to help organise shared modes of transport for groups of people in rural areas, and in the future, driverless cars may offer an additional transport option for people living with dementia.

Improved awareness of dementia among travel staff

Improving awareness of dementia among transport staff, and developing training programmes on how to respond to the needs of passengers with dementia, is another key way in which services can be improved.

For example, East Anglia Trains, has worked with the Dementia Society to deliver a dementia-awareness training pilot for staff at four of its stations, and plans to roll this out to all East Anglia staff. Arriva Rail Northern has also announced funding to develop the Bentham Line from Leeds to Lancaster and Morecambe as a ‘centre of excellence’ for people with dementia.

Transport assistance cards are another example of possible ways to improve transport for people with dementia. These cards record details of an individual’s needs so that the individual can show the card privately to the driver or other travel staff as a means of asking for extra assistance. Many individual transport operators and local authorities across the country already issue such cards. Standardising these schemes across the UK may be one way to help improve people’s confidence when using public transport.

Future developments

While these initiatives are making a significant impact, there is still much to do. If the growing number of people living with dementia are to maintain their independence, then it is essential that transport services become more dementia-friendly. Bringing together the shared knowledge and experiences of those living with dementia, and the skills and experience of professionals involved in the design and delivery of transport services will help to create a more inclusive, person-centred public transport system.

Dr Joy Watson, an ambassador for the Alzheimer’s Society who herself has been diagnosed with dementia, sets out an admirable goal:

“A diagnosis of dementia is not the end of the road, but the beginning of a new journey. Some people need a little more help to take the first steps, and if I can contribute to them living well, then my mission is fulfilled.”

The population is ageing. People are living longer, and are in need of greater levels of care than ever before. But how is this increase in life expectancy and demand for care being met in prisons? Our prison population is also ageing, at a time when the sector is under increasing pressure, low staff numbers, higher levels of prison violence and disorder, and poor, crowded living conditions. In an environment which is largely designed to support young, able bodied men, how are prison staff and care teams liaising to help meet the needs of older prisoners?

A care plan for ageing prisoners

A report published in 2017 by the Scottish Prison Service called for a specific care plan for ageing prisoners to react to and provide planning to reflect the change in demographic of the prison population. The report found that between 2010 and 2016, the number of men aged over 50 in Scotland’s prison population rose by more than 60%, from 603 to 988. According to a Ministry of Justice report on prison population, the number of inmates aged over 50 is projected to grow from 12,700 to 13,900 by the end of June 2020, a rise of 9.5%, while the number of over-60s behind bars will grow by 20% from 4,500 to 5,400 over the same period.

In July 2017 Prisons and Probation Ombudsman produced the Thematic Review: Older Prisoners, which stated that HM Prison and Probation Service needs a national strategy to address the needs of the increasing numbers of elderly prisoners. It highlighted six areas where lessons still needed to be learned: healthcare and diagnosis, restraints, end-of-life care, family involvement, early release and dementia, and complex needs.

The difficulties older prisoners face on prison estates are far reaching. Not only are there physical barriers to moving around and living within a prison environment, but the increased mental health and social care burden is significant, as well as the potential need to begin end-of-life care. Many prison inmates suffer from multiple, longstanding and complex conditions, including addiction, and these conditions are exacerbated by a phenomenon known as “accelerated ageing”, which suggests that prisoners age on average 10 years faster than people of the same age in the wider community.

While some prisons have effective care plans which allow older prisoners to live with dignity, often older prisoners rely on the goodwill of officers and fellow inmates to meet the gaps in their care needs. And while in England and Wales the Care Act means that, a statutory requirement to provide care lies with the local authority within which the prison is located, this is not a guarantee. Calls have been made for care planning in prisons to become more robust, with minimum standards of care and a clear pathway of delivery, with accountability and responsibility of specific bodies being made explicit.

Prison staff, care teams and the NHS in partnership

Any care planning for older people needs input from a number of different sources, and care planning for older people in prison is no different. It will require input from professionals across health, social care, and housing and the criminal justice system as well as wider coordination support and legislative and financial backing from central and local government.

Prisoners with physical disabilities or diseases such as dementia need specialist care at a level that standard prison officers cannot give. Research has suggested that prison staff are being expected to shoulder this extra burden, often having to perform beyond their duty to care for and look for signs of degeneration in prisoners, particularly those who show signs of Alzheimer’s and dementia.

A number of research studies have looked at the provision of training and the use of additional, multi-agency staff to try to bridge the gap in care for elderly prisoners. In 2013 a review was conducted of multiple prisons, including some in England, the USA and Japan, which examined the training available on each estate for prisoners with dementia and similar conditions.

As well as social care needs inside prison, specific rehabilitative needs of older prisoners being released from prison is also something that prison charities and reform bodies are keen to raise onto the agenda. A report from the Prison Reform Trust in 2016 highlighted the challenges of rehabilitative and parole needs of older prisoners, commenting that older people released from prison are being “set up to fail” by a lack of adequate provision to meet their health and social care needs on release. It highlights the limited and inconsistent housing, employment, debt and substance abuse advice available specifically for older offenders and suggest that their particularly vulnerable position puts them at risk of serious harm or reoffending.

Final thoughts

The population of older prisoners in our prisons is growing, and it is clear that a comprehensive strategy is needed to ensure that the specific, and at times unique care needs of these prisoners are met. This will mean greater cooperation from social care, health and criminal justice agencies, but will also mean reassessing how we think about social care, how it should be delivered and funded. The needs of older prisoners go beyond physical adaptations, to mental health, dealing with social isolation, the onset of chronic illnesses and at times the provision and planning of end of life care.

According to the Alzheimer’s Society, there are currently around 850,000 people living with some form of dementia in the UK. Although the risk of developing dementia increases with age, it is not just a disease of the elderly. There are currently around 40,000 people with dementia in the UK under the age of 65.

The vast majority of cases of dementia cannot be cured. However, there is a lot that can be done to enable someone with dementia to live well with the condition. Many people with dementia can continue lead active, healthy lives for years after diagnosis. Even most elderly people with mild to moderate dementia can continue to live in their own homes.

The importance of good urban design

Evidence has shown that well-planned, enabling environments can have a substantial impact on the quality of life of someone living with dementia and their ability to retain their independence for longer.

For example, being within easy walking distance of shops and other local amenities can help people with dementia to remain physically active and encourages social interaction.

Having access to green space and nature also has particular benefits, including better mood, memory and communication and improved concentration.

Key characteristics of a dementia-friendly environment

Drawing on the principles set out in ‘Neighbourhoods for Life’, the RTPI advises that urban environments should be:

Familiar – functions of places and buildings made obvious, any changes are small scale and incremental;

Legible – a hierarchy of street types, which are short and fairly narrow. Clear signage;

Distinctive – including a variety of landmarks and a variety of practical features, e.g. trees and street furniture;

Accessible – access to amenities such as shops, doctor’s, post offices and banks within easy, safe and comfortable walking distances (5-10 minutes). Obvious, easy to use entrances that conform to disabled access regulations;

Comfortable – open space is well defined with public toilets, seating, shelter and good lighting. Background and traffic noise minimised through planting and fencing. Minimal street clutter;

In addition to specific guidance on how to improve the urban environment, the RTPI practice note also highlights the crucial role of planners in the creation of ‘Dementia Friendly Communities’.

This is a recognition process, which publicly acknowledges communities for their work towards becoming dementia friendly. It aims to involve the entire community, from local authorities and health boards to local shops, in the creation of communities that support the needs of people with dementia.

There are 10 key areas of focus. Those particularly relevant to planning include:

shaping communities around the needs and aspirations of people with dementia;

By 2025, it is estimated that the number of people diagnosed with dementia will rise to over one million. Significant under diagnosis means that the number of people who experience dementia may be even higher.

However, the RTPI report that at present few local authorities have made explicit reference to dementia in their adopted local plans.

Worcestershire County Council and Plymouth City Council are notable exceptions:

Worcestershire are currently developing a draft Planning for Health Supplementary Planning Document that covers age-friendly environments and dementia.

A beneficial environment for all

While these are important first steps towards the greater recognition of the role of planning in supporting people with dementia, it is imperative that planning explicitly for dementia becomes the rule, rather than the exception.

Not only will this benefit people with dementia and reduce healthcare costs, it may also benefit the wider community, including young families, people with disabilities, and older people.

As the RTPI rightly state, “environments that are easy for people to access, understand, use and enjoy are beneficial to everyone, not just older people with dementia.”

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Earlier this month, it was reported that dementia had overtaken heart disease as the leading cause of death in England and Wales. And caring for those with dementia is becoming the major social care challenge of the 21st century – over 1 million people in the UK are expected to have dementia by 2021.

Despite significant research into the condition, there are no long-term cures. As a result, health and social care teams, and researchers into the health and well being of older people, have started to promote non-pharmacological ways of alleviating symptoms and reducing distress to the patient and their family.

Many of these techniques are widely accessible, require little to no formal care training and can take place either in the patient’s own home or in a care home setting. One of these techniques is the use of music as a form of therapy. While specially trained dementia and Alzheimer’s music therapists exist to give formal therapy, carers and family members can also use music to help improve the quality of life of a person suffering from dementia or Alzheimer’s.

Benefits of music therpay in dementia care

Research and experiences from practice regularly show similar outcomes when using music with dementia care patients. The benefits that are consistently highlighted include:

Music evokes emotion – and this in turn can evoke memories which can help sufferers and family members to connect together.

Musical aptitude and appreciation are two of the last remaining abilities in dementia patients – it is one of the first cognitive skills we develop as new-born children and is one of the last things to leave us in degenerative cognitive diseases.

Music can bring an emotional and physical closeness – the association that a patient makes with a song can encourage them to complete actions such as dancing or hugging which they associate with that piece of music. It can also enhance feelings of security and safety among vulnerable patients.

Singing can be used as a way to engage and to encourage people to express feelings, even if it does not include words or sentences. It can be a way to encourage participation and socialisation, as well as stimulating brain activity, dexterity and physical activity if actions are also introduced to go along with the words.

Music has been proven to stimulate the release of hormones which gives it the ability to shift mood and manage stress.

“Come fly with me … Let’s make a cup of tea”

One project from Purple Angel music has rewritten and altered the lyrics to some well-known songs which are loaded onto an iPod and can be placed in a person’s home to remind them to carry out day-to-day tasks such as eating and drinking, locking their front door, turning off their fire and showering.

The pre-loaded iPod, which comes in a number of musical genres, contains two 12-hour tracks – one which plays the lyrically-amended songs at two hour intervals throughout the day to act as a reminder service, and the other which is 12 hours of silence, designed to allow the patient to sleep without having to remember to turn off the iPod.

Examples of the altered tracks include:

L.O.V.E, I’d love a cup of tea – a song to encourage rehydration via a cup of tea

That’s Amore, That’s a bath day – a song to encourage taking a shower or bath

Let There be Love, Let there be lunch – a song to encourage eating

Can’t take my eyes off of you – a song to encourage night time requirements, like locking the door and turning off the fire.

A playlist for life

In August 2016, the Care Inspectorate backed a scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

“Music can reveal previously hidden aspects of the patients to their carers; likes and dislikes, talents and memories – it all helps piece together the jigsaw of an identity obscured by illness.”

As the video above shows, using music can also be a way for family members to re-engage with the person suffering from dementia. It also allows them to feel like they are directly involved in a positive element of care, as they are often invited to create the playlist, using songs that they know will evoke specific memories or emotions for the patient, and then listen along with them, interacting as they do so.

Similarly, Music for Life, a project run jointly by London’s Wigmore Hall and the charity Dementia UK brings specially trained musicians into care homes to work with patients, carers and family members in group and 1-2-1 sessions, creating and listening to music. Musicians, care home staff and managers meet after each session to reflect on what they have learned about the patients – knowledge that helps in future care and treatment.

Over 800,000 people currently live with the condition and roughly 25 million people – nearly half the UK population – are affected by it through knowing someone with the condition.

Music offers a way to care for people suffering from dementia in a sensitive, person-centred and cost effective manner. It can also be a vital tool to support families who can reconnect with their loved ones through a piece of music, even when other forms of communication have become difficult.

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A key focus of social care teams today is helping people to grow old at home, safely, with dignity and with appropriate levels of care if needed, without breaking the budget. Increasingly, local authorities are looking to advances in technology to facilitate this “growing old in place”.

Telecare packages and assistive technologies are often the preferred way for care teams to deliver social care in a home setting. And in situations where care is required around the clock (for example, support for people with dementia and other life limiting degenerative diseases), families and carers are adapting everyday technology and integrating it into their care-giving in order to supplement the telecare provided by local authorities.

Bricolage in dementia and elderly care

Bricolage means adapting an object to allow it to carry out a function which was not necessarily its original intended function. Relatives who care for loved ones with dementia, often adapt everyday objects to help them with their day-to-day caring. They find new, innovative and often non-conventional ways to use technology in diverse ways.

One example from dementia care was a man who bought a chicken ornament with a sensor which “crowed” whenever anyone walked past it. He placed it beside the front door so that if his wife, who suffered from dementia, walked up to the door to go out, he would hear and be able to go to her.

Other examples of technology being adapted include: setting alarms and reminders on mobile devices to remind people to take medication, or using webcams to act as personal CCTV so familly carers can monitor loved ones when they go out, or go into the next room.

These examples show that objects don’t have to be digital in order to be effective. The rise in capability of digital technologies and the relative decrease in cost, however, means it is often quicker and easier for families to invest in additional technologies themselves, rather than waiting for an assessment and an allocation of additional technology from their council.

Although there may be practical motivations, some charities have expressed concern about the ethics of some of the practices regarding adaptation of digital technology to form part of an assistive care package. While they recognise the strain of caring is significant for many people, rigging up a webcam in each room to allow you to “monitor” a loved one, or attaching a GPS tracking bracelet, for example, while often done with the best of intentions, could be interpreted as a breach of human rights.

Active assistive technology (technology which requires an active call for assistance) rather than passive technology (which is constantly monitoring) may be a better way of using technology ethically. It may also be used as an additional stimulant or interactive tool to allow patients to communicate. Apps and interactive devices, such as tablet computers, can inform a carer or loved one that someone had been using the app (providing a type of reassurance and monitoring) and the activities the app promotes might also be a visual stimulant and a communicative tool. The Dementia Citizens project has adopted this method and aims to help people with dementia and those who care for them, using apps on smartphones and tablets.

If we are mindful of the ethical challenges of integrating more technology into care, it might be possible for families and carers to work with social care and assistive technology development teams to adapt the tools available in a more empowering way. It might also mean that the onus is not on carers and their loved ones to build what they can from the standardised telecare provided by local authorities.

Bricolage in assistive care has, for many families, become the norm without them realising it. By adapting and supplementing assistive technology, like telecare packages, with non-assistive technologies or adapted additional digital technologies, families and carers can create a bespoke and personalised care package.

In future, understanding the extent to which families and carers adapt the technology given to them, could help creat more flexible care packages which can be more easily adapted to suit individual needs.

Ecotherapy, also known as nature-based or green care is an alternative therapy for people suffering from mental health issues. It can be delivered as an individual treatment or in combination with traditional medicinal and talking-based treatments. Charities and research has suggested that it can reduce depression, anger, anxiety and stress as well as improving self-esteem and increasing emotional resilience.

can take place in both urban and rural settings in parks, gardens, farms and woodlands

works through people either working in nature or experiencing nature

It can be structured or more informal, with some areas providing therapist led classes while elements of ecotherapy, such as taking walks or gardening, can also be done without specialist supervision, on your own or with family members and friends.

Therapy could be one to one or in a group and could also be delivered to people who are in residential care setting. AAT can also be used to assist mobility and coordination or simply to spend relaxed time with animals where patients can feed or pet them. This interaction can promote bonding between the individual and animal which has been found to reduce stress and anxiety.

Nature Arts and Craft Therapy

Nature based art therapy takes inspiration from nature to create and provide materials to create art work. This type of therapy can also include social and therapeutic horticulture (STH). This can be a particularly effective form of nature based intervention as it can be adapted to suit a wide range of mobility and abilities and could potentially lead to work experience or the sale of goods created, which in itself can build self-confidence and transferable skills.

This therapy focusses on using physical activities to encourage psychological support, It includes activities such as rafting, rock climbing and caving. Often done in a group, this type of therapy aims to build trust and raise confidence. While it can be strenuous, less able individuals can take part in green exercise therapy, which largely includes walks and rambling, or wilderness therapy (which includes physical group and team activities such as making shelters and hiking).

One of the main challenges the report highlights is to increase the availability of green therapies in order to make the practice more normalised within treatment. The authors also speak about the importance of standardising the use of terms such as ‘ecotherapy’, ‘green care’ and ‘nurture based interventions’ to allow people to fully understand what different interventions entail. The report makes nine recommendations, including:

expanding the evidence base around green therapy

increasing the scale of commissioning of green care initiatives

increasing collaboration between the green care sector and health and social care practitioners

Ecotherapy is still not widely accepted as a mainstream approach to mental health treatment. However, it is increasingly being offered as a combination therapy alongside traditional drug-or talking-based interventions. Advocates of ecotherapy hope that this will lead to wider acceptance of the approach and the positive effect it can have on people who suffer from mental ill health.

Advocates emphasise the holistic and person-centred benefits of ecotherapy, which has been shown to improve physical health as well as mental wellbeing. As the video below demonstrates, it increases social skills and in many instances can help people build new or develop existing skills which can help them enter, or re-enter employment. Potentially this may also reduce the burden on care and community mental health services.

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Talking about sexuality and intimacy can be an awkward and, for some, taboo subject, particularly when the people we are discussing are parents or elderly relatives.

However, in a care setting, where a relative has been moved into care, sexuality, sexual needs and questions around intimacy often remain un-talked about and un-catered for, and can create an awkward situation for residents, relatives and care staff.

For many people, intimacy is a ‘normal everyday’ part of life. But when moving into residential care, for many people, that is lost. They feel their privacy is taken away and their ability to conduct life as they had before needs to change as a result of moving from their home. The onset of conditions such as dementia in later life can also make other people uneasy about the idea of continuing with intimate relationships, or indeed starting new ones later in life. One of the aims of the research conducted by a team at Manchester University on older people’s understanding of sexuality (OPUS project) is to look at erotophobia, or a fear of older people’s sexuality (within the remit of feelings and beliefs on sexuality more generally).

The loss of identity through sexual expression can be even more explicitly felt by members of the LGBT community, many of whom, studies have found, have felt the need to ‘go back into the closet’ upon entering residential care.

In 2010 the World Health Organisation (WHO) published a set of sexual rights. In this the right of the individual to choice is key and something which care homes must still respect.

Sexual rights in older people was also the subject of a report by the Royal College of Nursing who commented that “when someone moves into a care home, to all intents and purposes the private space of their room is exactly that, their private space and provided any acts are consensual care homes should facilitate the wishes of residents to the fullest extent.” Within a human rights context, adults living in residential settings, unless they have had certain rights and freedoms curtailed or restricted by the law, generally have the same basic rights and freedoms as any citizen to live their lives as they wish. This includes possibly doing things that others might consider to be unwise or inappropriate.

In addition, although many decisions about care within a care home setting are taken in consultation with the family of the resident, carers and care home managers must also remember that they have a duty to their patient, and there is a level of patient-carer confidentiality which carers should be mindful of when discussing topics such as sex, sexuality or intimacy.

However, in that context it is also the case that care home workers have a duty of care, to protect vulnerable people from abuse, exploitation and situations which they might find distressing. The International Longevity Centre have produced a guide which contains advice around intimacy and sexuality in care homes, looks at intimacy in older people, (particularly older people with dementia) and the position of people within the LGBT community who move into residential care.

Many within the LGBT community have expressed a feeling of discrimination or anxiety about their sexuality on entering residential care and as a result there are suggestions of LGBT only residential care homes being created, with one proposed for either London or Brighton in the next few years.

The legality behind many of the decisions taken in care homes is set out in law, including definitions of consent, abuse, exploitation, violence. However, the individual practices of care homes regarding policy is often set out and implemented at the discretion of care home managers and staff and it is their responsibility to ensure that they have an effective and consistent policy in place when it comes to sexuality, intimacy and relationships more generally.

They also have a responsibility to ensure that staff are suitably trained to tackle any issues which may arise, answer any questions from residents or family members and recognise boundaries and levels of appropriateness while still delivering care to residents. Care workers must balance delivering effective care with promoting personal emotional and mental well being, allowing residents a level of freedom and personal choice while ensuring adequate safeguards are in place. This is not an easy task. However, more research is currently being conducted, and improved training for staff is also being increasingly offered as the norm.

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Recent research has suggested that the rate of growth in the prevalence of dementia may be levelling out as the general health of the population increases. While such findings are encouraging, commentators have pointed out that increasing rates of obesity and diabetes, as well as the fact that people are living longer, means they have to be treated with caution.

Whether we face a continuing increase, a stabilisation or a decline in dementia, for those who are affected it will continue to have a devastating impact. And this includes not just the person with dementia, but also their loved ones and those who care for them.

A recent enquiry to our Ask a Researcher service asked for our help on this very question. As a social worker needing to understand the broader impacts of the disease on the family in order to be to provide appropriate help and support, the enquirer came to us looking for the available research evidence on the impacts of dementia on those caring for them. Our researcher was able to provide a comprehensive roundup of the current literature, highlighting the variety of issues facing carers of those with dementia.

Carers’ working lives

Not all the issues covered were ones that might be immediately obvious, like the practicalities of caring and the emotional impact of seeing a loved one affected. For example, one piece of research we were able to flag up examined the impact on carers’ working lives and workplace relationships.

Over half of respondents to a survey (53%) said that their work had been negatively affected due to their caring responsibilities. The survey highlighted the pressure on those in the prime of their working life, most often women, who are combining care for an older relative, often at a distance, with a range of other family responsibilities.

Minority ethnic carers

We also highlighted research on the way dementia can affect different sectors of the population. One recent study we identified, examined how the migration experiences and life histories of Sikhs living in Wolverhampton impacted on their experiences of caring for a family member with dementia and the barriers to accessing services.

It found that, rather than cultural differences, it was migrants’ experiences and perceptions of social exclusion, their perceived and actual social position as migrants, that affected the ways in which they accessed services.

Communicating with family members who have dementia

As well as drawing together a range of research on carers’ experiences and difficulties, we were able to include examples of initiatives, such as Talking Mats, which can help to improve the experience of caring for a loved one with dementia.

Talking Mats are a simple communication tool, developed at the University of Stirling, to help people with communication difficulties to express their views. It uses a simple system of picture symbols that allow people to indicate their feelings about various options relating to a topic.

Research for the Joseph Rowntree Foundation looked at their use for people with dementia and their family carers. It found that, unexpectedly, although the people with dementia and the family carers both felt more involved in discussions using Talking Mats, the increased feeling of involvement was significantly higher for the carers. Carers repeatedly reported feeling ‘listened to’ by the person with dementia and felt that their loved one could actually ‘see’ their point of view. It found that many family carers said they often choose not to say something that is going to inflame a situation, so instead they say nothing at all. Whereas the Talking Mats tool allowed them time and space to have their say, and helped to organise and structure their conversation with the person with dementia for whom they cared.

Our response to the enquiry provided our member with a speedy and concise roundup of the currently available literature on the issues and difficulties facing those who provide vital care for people with dementia.

Our popular Ask a Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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Nesta’s LabWorks 2015 global lab gathering kicks off today in London, bringing together innovation labs, units, offices and teams working within and with government to address social challenges.

Today on the blog we look at social labs, their potential to improve public services and a couple of social labs who are carrying out innovative work in public services.

What are social labs?

Social labs are platforms for tackling complex social challenges.

Zaid Hassan highlights the following key characteristics of social labs:

They are social, facilitating participation by a broad range of stakeholders

They are experimental, taking an iterative approach to problem-solving

They are systemic, seeking to address the root cause of a problem, and not just its symptoms (Hassan, 2014, p.3)

Social labs draw inspiration from design thinking, which is centred on the following principles of design which were promoted by design firm IDEO:

A user-centred approach to problem solving

Using direct observation as a main source of learning

Moving quickly to creating prototypes as a means of generating additional knowledge

Learning from failures to refine and redevelop

Social labs in the public sector

The public sector is making increasing use of design, policy or social labs as a means of complementing and reinforcing skills in public policy, programme and service design. They contribute a different perspective to challenges and use a range of research methods and facilitation techniques to foster ideas and insights that attempt to incorporate many different points of view.

Recent Canadian research on a What Works Lab, which was established to develop approaches to increase employer engagement in workplace training, found that using lab methodology enhances the ability to generate insights into potential policy responses, and that lab techniques can also substantially reduce the transmission cycle between research, policy and service delivery. The research also highlighted how experimentation in a lab setting can be used to de-risk an initiative before wider implementation, and demonstrated that labs are an effective means of generating high-quality policy work.

Social Innovation Lab Kent (SILK)

SILK is a small team based within Kent County Council established in 2007 to ‘do policy differently’. They consider that the best solutions come from people who are at the heart of an issue, those with lived experience, families, friends, volunteers, and front line workers, and they ensure that these groups are involved at all stages their projects.

Projects are broken down into the following phases:

Initiate. Involve the right people, create a project plan collectively and decide who needs to be informed about the project.

Create. Collect as many insights as possible, involve a broad range of stakeholders and generate ideas for testing in the next phase.

Test. Test the ideas which were proposed during the create phase, and continue testing until a model that woks is identified. Trial runs, prototypes or ‘mock ups’ can be a part of this process.

Define. A model which has been tested and known to work is defined and consolidated.

SILK has delivered a variety of projects across the themes of future services, service (re)design and sustainable services, and tackled a range of social issues, including accessible and affordable food, the resettlement of offenders and creating a dementia-friendly community.

MindLab

Based in Danish central government, MindLab employs a human-centred design approach to address public sector challenges. Its board sets its strategic direction and approves its portfolio of projects, ensuring that their work is aligned with their sponsors’ priorities. Its emphasis on human-centred design helps to forge links between the perspectives of end users and government decision making.

MindLab’s team has a variety of skills which are indicative of its ethos and method, including social research, design, public administration, project management, organisational development and creative facilitation.

In one project MindLab worked with National Board of Industrial Injuries (ASK) to increase the number of people who remain in employment after suffering an injury at work. MindLab highlighted the potential in strategic working across working across public, private and non-governmental organisations and a change in attitude in helping these people return to the labour market.

MindLab interviewed people who had suffered industrial injuries and put together service journeys, which mapped the different stakeholders involved in a work injury case from a citizen’s perspective. They demonstrated through a case study how cooperation between the municipality, the insurance company and ASK improved an injured person’s employment prospects. MindLab also conducted internal workshops with ASK management to support a change in strategic focus from case resolution to employment outcomes for injured people.

It is clear that social labs are taking a different approach to policy and service delivery, focusing on the experiences and needs of service users to devise innovative solutions to a range of social challenges.

The Idox Information Service can give you access to a wealth of information on economic and social policy and public service delivery. To find out more on how to become a member, contact us.

Further reading

Hassan, Zaid (2014). The social revolution: a new approach to solving out most complex challenges. San Francisco: Berrett-Koehler Publishers, Inc. (Available for loan from the Idox Information Service Library)